Pertussis: a concise historical review including diagnosis ... - sepeap

80 Reviews in Medical Microbiology 2005, Vol 16 No 3
German) kinkhoste is found in a source from 1464.
Dodonaeus (1517–1585) in his Cruijde boeck [8] (book of
herbs) from 1554 already describes cures for the kieckhoest!
De Baillou called it quinta, referring to Hippocrates [1].
Coqueluche, the present name in French for whooping
cough, was then the common name for influenza [9].
Holmes [10] reports that pertussis was called chyne-cough
in England as early as 1519. Cherry and Heininger [11]
say it was called the kink (in Scottish synonymous with fit
or paroxysm) and kindhoest (a Teutonic word meaning
child’s cough) in the Middle Ages. Nils Rosén von
Rosenstein [6] calls it in his book about paediatric diseases
from 1798 Keichhussten. InaJAMA editorial [12] names
such as tosse canina (dog’s bark, Italy), Wolfshusten (howling
of wolves) and Eselshusten (braying of donkeys) (both
from Germany), and chincough (boisterous laughter, Old
English) are given. In Chinese it is called ‘‘cough of
100 days’’ [13]. In Dutch it is called kinkhoest, coming
from old names as kinkhôste, kichhoest, keichhusten, asvan
Esso describes [14]. In the Dictionary of the Dutch
Language (Woordenboek der Nederlandsche Taal) [15] the
same names are given, and others as kie(c)khoest, kijkhoest,
kikhoest. Also it refers to Dodonaeus (1517–1585) who
called the disease kich,orkinchoest in a latter edition of his
‘‘Cruydt-Boeck’’ from 1608 [16].
Since in these old days there were no possibilities to prove
the diagnosis we will never know whether all these
diseases then were the same as our whooping cough that,
as we know today, is caused by B. pertussis, or that they
were pertussis-like syndromes, caused by one or more
other pathogens [17–23].
stage usually lasts 1–6 weeks, but may persist for up to
10 weeks.
Young infants (under 6 months of age) may not have the
strength to have a whoop, but they do have paroxysms of
coughing. The cough though may be absent and disease
may then manifest with spells of apnoea [24].
Although pertussis may occur at any age, most cases of
serious disease and the majority of fatalities are observed
in early infancy. The most important complications in
the USA are hospitalization (72.2% in children younger
than 6 months, 3.9% for those over 20 years of age),
bronchopneumonia (17.3 versus 3.4%), seizures (2.1
versus 0.5%), acute encephalopathy (0.5 versus 0.1%), the
latter frequently resulting in death or lifelong brain
damage, and death (0.5 versus 0) [25]. Heininger reported
in proven pertussis patients in Germany an overall
complication rate of 5.8%, pneumonia (29%) being the
most frequent complication. In infants less than 6 months
of age, the rate of complications was 23.8% [26].
At the end of the catarrhal phase, a leukocytosis with an
absolute and relative lymphocytosis frequently begins,
reaching its peak at the height of the paroxysmal stage. At
this time, the total blood leukocyte levels may resemble
those of leukaemia ( 100 000/ml), with 60–80%
lymphocytes.
The convalescent phase, the last stage, lasting 1–3 weeks,
is characterized by a gradual, continuous decline of the
cough before the patient returns to normal. However,
paroxysms often recur with subsequent respiratory
infections for many months after the onset of pertussis.
Fever is generally minimal throughout the course of
pertussis.
Clinical manifestations
Clinical manifestations of whooping cough may show
substantial variation, depending on previous vaccination,
earlier infection with B. pertussis, age or the clinical
condition of the patient. The clinical course is divided
into three stages. After an incubation period of 5–10 days,
with an upper limit of 21 days, illness begins with the
catarrhal phase. This phase lasts 1–2 weeks and is usually
characterized by low-grade fever, rhinorrhoea, and progressive
cough.
In the subsequent paroxysmal phase, lasting several
weeks, B. pertussis causes severe and spasmodic cough
episodes with a characteristic whoop, often with cyanosis
and vomiting. The patient usually appears normal
between attacks. Paroxysmal attacks occur more frequently
at night, with an average of 15 attacks per 24 h.
During the first 1 or 2 weeks of this stage the attacks
increase in frequency, then remain at the same level for 2–
3 weeks, and then gradually decrease. The paroxysmal
Microbiology
The genus Bordetella contains species of related bacteria
with similar morphology, size, and staining reactions. To
date there are eight species known of Bordetella:
B. pertussis [27], B. parapertussis [28,29], B. bronchiseptica
[30], B. avium [31] (formerly designated Alcaligenes
faecalis), B. hinzii [32,33] (formerly designated A. faecalis
type II), B. holmesii [34], B. trematum [35] and B. petrii
[36]. Bordetella pertussis, B. parapertussis and B. bronchiseptica
are genomically closely related. The first four are
respiratory pathogens. Bordetella pertussis is an obligate
human pathogen. Bordetella pertussis was long considered
the sole agent of whooping cough. A mild, pertussis-like
disease in humans may be caused by B. parapertussis and
occasionally by B. bronchiseptica. Bordetella parapertussis
appears both in humans and animals. The natural habitat
of B. bronchiseptica is the respiratory tract of smaller animals
such as rabbits, cats, and dogs. Human infections with